modern_pci_summit_final_for_medicl_education.pptx

Modern PCI Summits bring together leading cardiologists, interventional specialists, and healthcare professionals to discuss the latest advancements in Percutaneous Coronary Intervention (PCI). The summit focuses on innovative techniques, updated clinical guidelines, case studies, and emerging technologies that are transforming interventional cardiology. It serves as a platform for sharing knowledge, improving patient outcomes, and exploring the future of minimally invasive cardiac care.


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Modern PCI, PCI Summit, Percutaneous Coronary Intervention, Interventional Cardiology, Coronary Artery Disease, Angioplasty, Cardiology Conference, Stent Technology, Heart Disease Management, Clinical Practice, Evidence Based Medicine, Cardiology Updates, Medical Education, STEMI Treatment, Cardiac Catheterization, Healthcare Innovation, Minimally Invasive Cardiology, Cardiovascular Research, Modern Healthcare, Cardiology Training

1. MODERN PCI SUMMIT: AGENDA & OBJECTIVES Presented by DR. JAGHAT SHIWLANI Consultant Interventional Cardiologist SICVD Larkana

2. Modern PCI Trends & Guidelines • Latest ESC & ACC PCI guideline updates • Physiology-guided PCI (FFR/iFR) status • Role of imaging vs angiography-only era

3. How Imaging Has Transformed My Modern PCI Practice? • IVUS improves stent optimization & reduces restenosis • OCT for calcium assessment & thrombus visualization • Imaging has shifted PCI from art to precision science 🔄 REAL IVUS/OCT CATH-LAB IMAGE WILL BE INSERTED HERE (Authentic Luminal Cross-Section) ✅ IVUS-based authentic grayscale luminal cross-section image incoming (calcific arc visible) 🔍 Annotated teaching-view IVUS (with calcium arc + acoustic shadowing labels) will be inserted here.

4. The Current State of Calcium Modification Tools & Techniques • ESC 2024: IVUS recommended Class I for complex PCI • ACC/AHA: Imaging-guided PCI improves MACE outcomes • Syntax II: Imaging + physiology superior to angiography-only PCI

5. Is There a Right Way to Treat Calcium - or Just Better Tools? • IVUS: Detects calcification arc, thickness, landing zones • OCT: High-res for calcium depth & stent apposition • Pearl: Visual assessment > angiographic guesswork

6. From Challenge to Success: Real-World Boston Scientific Experience - Part 1 • Calcium types: Superficial vs Deep vs Nodular • Strategy: Modify before metal — imaging decides tool • Pearl: Underprepared calcium is the mother of stent failure

7. Design Features of WATCHMAN FLX • Imaging-based calcium phenotype defines strategy • Rotablator: Concentric, dense, superficial calcium • IVL: Deep circumferential calcium with poor balloon yield • Pearl: Operator preference ≠ optimal calcium tool — science decides

8. Patient Selection and Indication • Real-World Boston Scientific PCI Strategy • WM FLX: Precise left atrial appendage closure architecture • High MVARC safety — procedural seal superiority • Pearl: Modern structural interventions > surgery in select anatomies

9. The OPTION Trial • The OPTION Trial — Key Findings • WM FLX non-inferior to DOACs for stroke prevention • Reduced long-term bleeding risk — paradigm shift • Pearl: LAAO now Class IIa in select AF patients — not last resort

10. IVUS Guided-PCI Simplified by AVVIGO+ • AVVIGO+ IVUS — Practical Lab Advantage • Instant automated lumen & calcium quantification • No delay — accelerates optimization vs angiography only • Pearl: Image once, stent right — not stent, then image disaster

11. The Right Tools for the Right Lesion: Rotablator / Wolverine • Right Tool for Right Lesion — Final Strategy • Rotational Atherectomy — Undilatable calcific rings • Wolverine (Cutting Balloon) — Focal fibrotic resistance • Pearl: Lesion biology > tool brand — prep determines stent longevity

12. Modern PCI Algorithm — Imaging First Strategy • Step 1: Angio + IVUS/OCT for true lesion assessment • Step 2: Define calcium phenotype — arc, depth, distribution • Step 3: Choose modification tool (RA / IVL / Wolverine) • Step 4: Re-image BEFORE stent — not after failure • Pearl: Imaging is not optional — it is pre-stent decision making

13. Clinical PCI Laws — Real-World Pearls • Law 1: Under-imaged PCI = Under-optimized PCI • Law 2: Calcium is not seen — it is quantified • Law 3: You do not 'rescue' a badly deployed stent • Law 4: Tool follows lesion — not habit • Law 5: If you don’t image, you are gambling — not intervening

14. Backup: IVUS vs OCT — Practical Differences • IVUS: Deep calcium, lesion length, stent apposition • OCT: Calcium thickness, thrombus, cap rupture • IVUS — physiology & optimization • OCT — precision morphology

15. Backup: Calcium Phenotype Classification (IVUS/OCT Visual) • Concentric arc ≥270° = high resistance • Nodular calcium = RA preferred • Deep circumferential = consider IVL • Focal fibrotic = cutting/scoring balloon

16. Backup: OPTION Trial — Key Inclusion Criteria Snapshot • AF non-valvular; stroke risk ≥2 (CHA2DS2-VASc) • Not contraindicated to anticoagulation • WM FLX vs DOAC efficacy & safety data • Paradigm: LAAO is early, not end-stage

17. Thank You — Discussion Open • Precision PCI is not future — it is current standard

18. IVUS vs OCT — Which Modality When? IVUS: Deep penetration • Calcium characterization • Optimal for LMCA & ostial lesions OCT: High-resolution • Thin-cap fibroatheroma • Limited in heavy calcification Guiding principle: IVUS for strategy • OCT for precision